Provider Demographics
NPI:1770614489
Name:MOSLEY, CHERYL ELIZABETH (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ELIZABETH
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ELIZABETH
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3120 NE 158TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5111
Mailing Address - Country:US
Mailing Address - Phone:971-269-5331
Mailing Address - Fax:
Practice Address - Street 1:651 WAKE AVE STE A
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-352-2257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650151NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily